Cardiac abnormalities in cirrhotic children: pre- and post-liver transplantation.

BACKGROUND/AIM: Liver cirrhosis is associated with several cardiac abnormalities. There have been few studies of these abnormalities in cirrhotic children post-liver transplantation (LT). The purpose of this study was to evaluate cardiac abnormalities in cirrhotic children pre- and post-LT. METHODS: All cirrhotic children <15 years of age on a waiting list for LT underwent pre-LT echocardiography to evaluate left ventricular (LV) dimension, mass, and function. Repeated studies were performed at 1-2 and 3-6 months post-LT. RESULTS: A total of 20 cirrhotic children (median age 21.5 months [8-108 months], 11 female [55 %]) were enrolled in the study. Most patients had biliary atresia (75 %) and decompensated cirrhosis, with a median pediatric end-stage liver disease score of 19.5 (14-28). Two patients subsequently died, at 1 and 4 months post-LT. Echocardiography was re-evaluated in 17 and 18 patients at 1-2 months and 3-6 months post-LT, respectively. Prior to transplant, most patients had cardiac abnormalities, including LV enlargement (50 %), increased LV mass (95 %), abnormal LV geometry (95 %), hyperdynamic LV systolic function (60 %), LV diastolic dysfunction (60 %), and high cardiac index (75 %). At 3-6 months post-LT, no significant decrease in cardiac abnormalities was noted; however, cardiac parameters including LV dimension in diastole index and z-score, LV mass index, and relative wall thickness were significantly decreased. CONCLUSIONS: Most cirrhotic children had cardiac abnormalities, including LV enlargement, increased LV mass, abnormal LV geometry, and LV dysfunction. These abnormalities tended to improve post-LT. We suggest that echocardiography should be performed in all cirrhotic children.

Modified percutaneous endoscopic gastrostomy tubes: experience in Thai children.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a well-established alternative to open gastrostomy for providing long-term enteral nutrition. Although the commercial PEG tube is available and suitable for the procedure, its cost is relatively high for low socioeconomic people. Therefore, modified PEG tubes have been used in our hospital. OBJECTIVES: To evaluate the outcome and complications of PEG performed in children at Ramathibodi Hospital and compare the results between the commercial PEG and modified PEG tubes. METHOD: All children who had PEG performed at Ramathibodi Hospital, from January 1999 to May 2002, were included in the study. The demographic data, indications for PEG, types of PEG tube, outcomes and complications were retrospectively reviewed. The modified PEG tube was made by connecting a Malecot four-wing catheter to the previously used, re-sterilized distal part of a commercial PEG tube. RESULTS: PEG was performed on 34 children, aged 4 months to 13 years, and successfully placed in 30 children (88.2%). The commercial and modified PEG tubes were used in 20 cases and 10 cases, respectively. Early complications occurring in the first 7 days post-procedure were found in 9 cases (30%) as follow: peritonitis (1 case), peristomal wound infection (7 cases), and subcutaneous emphysema (1 case). Late complications occurring at more than 7 days post-procedure were found in 15 cases (50%) and all were minor problems. There was no difference in complication rates between the 2 types of PEG tubes. CONCLUSION: PEG is safe even in small infants. Minor complications are common but can be simply managed. The modified PEG tube is an alternative for a commercial PEG tube in an unaffordable situation.